Abstract
BackgroundPercutaneous endoscopic lumbar discectomy (PELD) is a promising minimally invasive treatment for lumbar disc herniation (LDH). Postoperative rehabilitation can improve patient outcomes. Not only rehabilitation for surgical trauma but also rehabilitation for lumbar spine and lower kinetic chain dysfunction should be performed. The aims of this study were to investigate the efficacy of a lumbar kinetic chain training for staged rehabilitation after PELD for LDH.MethodsFifty one LDH patients treated with PELD were studied. After surgery, patients underwent lumbar kinetic chain training for staged rehabilitation( staged group) or regular low back rehabilitation (regular group). The staged rehabilitation programme included three phases from 2 to 6, 7–12, and 13–24 weeks postoperatively, and different physical therapies were performed during these phases. The low back pain visual analogue scale (VAS), JOA score, ODI, SF-36, and cross-sectional area of the lumbar multifidus on MRI were assessed, and gait analysis was performed.ResultsTwenty five patients in staged group and twenty six patients in regular group were included. There were no significant differences in age or sex between the two groups at baseline (p > 0.05). The VAS score decreased and the JOA and SF-36 scores increased in both groups from baseline to 6 weeks (P < 0.05). In the staged group, compared with the regular group, the VAS and ODI scores were lower and the JOA and SF-36 scores were higher at 6 weeks (P < 0.05); the VAS and ODI scores were lower and the SF-36 score was higher at 12 weeks (P < 0.05); the SF-36 score was higher at 24 weeks (P < 0.05); the cross-sectional area of the lumbar multifidus showed no differences at 12 weeks (P > 0.05); and the left-right support ratio of gait was higher at 24 weeks (P < 0.05).ConclusionsThe staged rehabilitation programme for LDH after PELD promoted postoperative recovery, and the efficacy of lumbar kinetic chain training was higher than that of regular low back muscle exercise.
Highlights
Percutaneous endoscopic lumbar discectomy (PELD) is a promising minimally invasive treatment for lumbar disc herniation (LDH)
In the staged group, compared with the regular group, the visual analogue scale (VAS) and Oswestry dysfunction index (ODI) scores were lower and the Japanese Orthopaedic Association (JOA) and Simplified Chinese version of the health survey (SF-36) scores were higher at 6 weeks (P < 0.05); the VAS and ODI scores were lower and the SF-36 score was higher at 12 weeks (P < 0.05); the SF-36 score was higher at 24 weeks (P < 0.05); the cross-sectional area (CSA) of the lumbar multifidus showed no differences at 12 weeks (P > 0.05); and the ratio of the left to the right supporting phase of gait was higher at 24 weeks (P < 0.05) (Tables 4 and 5)
Because the main problem varies across recovery stages after PELD, this study developed a staged rehabilitation programme that differed by the period after surgery
Summary
Percutaneous endoscopic lumbar discectomy (PELD) is a promising minimally invasive treatment for lumbar disc herniation (LDH). Rehabilitation for surgical trauma and rehabilitation for lumbar spine and lower kinetic chain dysfunction should be performed. The aims of this study were to investigate the efficacy of a lumbar kinetic chain training for staged rehabilitation after PELD for LDH. Many patients with lumbar disc herniation (LDH) have been effectively treated with percutaneous endoscopic lumbar discectomy (PELD). LDH causes nerve root compression and lumbar spine and lower kinetic chain dysfunction [3, 4]. Postoperative rehabilitation should focus on lumbar surgical trauma and ways to improve the efficacy of PELD, prevent recurrence of LDH, and further improve function
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